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PubMed2000

Aggression and violence in health care professions.

Although violence is increasing in most workplaces, it has become a significant problem in health care professions. Not only has the number of incidents increased but also the severity of the impact has caused profound traumatic effects on the primary, secondary and tertiary victims. More health care professionals than ever are suffering from symptoms of post-traumatic stress disorder. Addressing the problem of violence in the workplace has been exacerbated by a lack of a clear definition of what constitutes aggression and violence. As a result, some administrators have been slow to commit resources to prevent further incidents and mitigate the impact. This article describes the magnitude of the problem from both an academic research and an operational perspective. A definition is presented as an initial step towards standardizing the research, and establishing an appropriate baseline upon which intervention policies and procedures can be created. This benchmark will also help to encourage empirical research into aggression and violence in health care professions and other professions. Further research needs to be conducted to create a comprehensive instrument that can more accurately measure the range of incidents and the severity of the impact.

Aggression↗

PubMed2003

Stepping outside the stereotype. A pilot study of the motivations and experiences of males in the nursing profession.

Despite their historical significance to the UK's nursing profession, numbers of registered male nurses here have seldom exceeded 10% of the total. This is not an immutable principle, given that countries such as the Netherlands manage to attract males to the profession in much greater numbers. This paper examines and critiques the available literature on males in nursing from both a historical and present day perspective. In so doing, it discusses factors such as caring, over-performance and career progression, and, notions of masculinity. It then moves on to outline and discuss an on-going pilot study specifically designed to examine the motivations and experiences of a sample of preregistration and postregistration male nurses in the UK, across a range of ages and ethnicities. The ultimate aim of the study is to produce evidence which will advance the recruitment of men to a profession which is currently experiencing severe recruitment difficulties. The paper presents themes emerging from the study to date, examining the implications these may have for the future management of nurse recruitment.

Adaptation, Psychological↗

PubMed1999

Attitudes of Hong Kong high school students towards the nursing profession.

The increased development of hospital services in Hong Kong over the last decade has given rise in the demand for more recruits to join the nursing profession. Despite the advancement in education and the improvement in the working conditions, the problems of attracting sufficient new recruits remain critical. This study aimed to examine high school students' attitudes towards the nursing profession and to identify the contributing factors affecting shortage of nurses within the context of Hong Kong. A convenience sample of 375 high school students was recruited. A questionnaire was used to measure their knowledge, attitudes and intention to study nursing. Descriptive and inferential statistics were used to describe their career preferences and to compare knowledge, attitudes and intention scales between gender and nursing exposure groups. Results indicated that the students were generally knowledgeable about nursing but were reluctant to pursue nursing as a career. However, students who were socially acquainted with a nurse demonstrated a slightly more positive attitude towards nursing and slightly higher intention to pursue nursing as a career compared with those having no social acquaintance with a nurse. Implications for promotion of nursing profession and limitations of the study were discussed.

Adolescent↗

PubMed2005

The Dundee Ready Educational Environment Measure (DREEM)--a generic instrument for measuring students' perceptions of undergraduate health professions curricula.

Students' perceptions of their educational environment have been studied at all levels of the education system, from primary through post-secondary education. Recent imperatives towards enhanced quality assessment monitoring at a time when health professions education is increasingly committed to student-centred teaching and learning have stimulated a revival of interest in this field. This paper reports a body of research in health professions institutions around the world based on the Dundee Ready Educational Environment Measure (DREEM), a reliable, validated inventory that claims to be generic to undergraduate health professions education and non-culturally specific.

Curriculum↗

PubMed2003

Medical specialization, profession, and mediating beliefs that predict stated likelihood of alcohol screening and brief intervention: targeting educational interventions.

Practitioner-level educational approaches that promote screening and brief intervention (SBI) seldom consider providers' profession and medical specialization. Strategies that consider these variables may be better equipped to affect change in beliefs and behavior. The aim of this study was to identify beliefs that predict stated likelihood of practicing SBI by specialty and health profession in order to guide the direction of educational strategies. Physicians and nurse practitioners were studied that specialized in family, internal, obstetric gynecology (ObGyn), and pediatric medicine. The results indicated that independent of amount of previous postgraduate alcohol education and knowledge, self-rated competence mediated between specialty and likelihood of practicing SBI. For instance, low self-rated competence for ObGyn was a barrier that suppressed likelihood of practicing SBI. Other findings were that role legitimacy mediated the association between profession and likelihood of SBI, so that lack of role legitimacy was a barrier for physicians but not for nurse practitioners. We suggest that targeted educational strategies for ObGyn and pediatric clinicians may prove more effective than the prevalent one-size-fits all approaches aimed at general adult populations.

Alcoholism↗

PubMed1988

Job stress in the health professions: a study of physicians, nurses, and pharmacists.

While considerable research has been devoted to job stress within individual health professions, little information has been available for comparing the sources or levels of stress among different groups of health professionals. To bridge that knowledge gap, the Health Professions Stress Inventory (HPSI) was administered via a mail questionnaire to 291 primary care physicians, 379 registered nurses, and 387 pharmacists randomly selected from across the United States. Mean stress scores on the HPSI were significantly different for all three professions, with nurses reporting the greatest levels of stress. Frequency of exposure to individual stressful job situations also differed significantly among the professional groups. While exploratory in nature, the results of this research emphasize the interprofessional differences that must be considered when considering the management of job stress in the health care system.

Adult↗

PubMed2000

Health professions education for adapting to change and for participating in managing change.

This paper outlines a case for a new approach to the education of future professionals. The magnitude and potential seriousness of changes to be anticipated in the first half of the new century challenge institutions of higher education to prepare their students to become able to adapt themselves to change and to participate in the management of change--not only in relation to their own profession, but more widely for the benefit of society at large. The Network of Community-Oriented Educational Institutions for Health Sciences is planning three major programs which are designed to help meet this challenge in the 21st century. The first of these programs will set out to identify generic competencies that are needed for adapting to change and for participating in managing change. This is to include not only profession-specific changes, but also changes that affect the well-being of society as a whole. The second program will address the related need to develop educational interventions that are designed to foster competencies for interprofessional and intersectoral collaboration. The third of these programs accepts that serious attention to effective education for the professions will require institutionalization of recognition and reward of creativity and commitment in education.

Journal Article↗

PubMed2002

Evaluating community-based health professions education programs.

This paper assumes the reader (1) has little knowledge about program evaluation, and (2) is interested in evaluation to improve a community-based health professions education program. There are other important and useful approaches that can be used to address an evaluation of a community-based health professions education program, and readers are encouraged to explore them--they appear in health education, public health education, in evaluation, and in program theory literature. The paper is organized around a group of questions as a reference or organizer for the reader. These include topics like why evaluation is wanted, what kinds of questions can be addressed through evaluation, who stakeholders are, who should conduct the evaluation, what methods can be used, and how to analyze data and report results from the evaluation. In the paper, I have attempted to include examples that are related to community-based health professions programs. Finally, the paper ends with the recognition that there is much more to learn in the field of evaluation and suggestions for ways to continue pursuit of knowledge in this topical area.

Journal Article↗

PubMed2004

Australian psychiatrists today: proud of their profession but stressed and apprehensive about the future.

OBJECTIVE: To examine the levels of satisfaction and stress of Australian psychiatrists. METHOD: A survey was mailed in December 2002 to all Fellows of the Royal Australian and New Zealand College of Psychiatrists residing in Australia; 1039 out of 2059 (50%) returned the questionnaire. RESULTS: The large majority of respondents (79%) were proud of being a psychiatrist. Most (88%) reported being satisfied with their work. Reasons for dissatisfaction varied between public and private psychiatrists. Private psychiatrists nominated litigation/indemnity issues as the most frequent (69%) while the most common for public psychiatrists was lack of beds (47%). The main reason for satisfaction was helping patients get better (72%). Sixty-two percent found their work in the previous 12 months to be stressful. Dissatisfied psychiatrists were 11 times as likely to report being stressed as those satisfied. In the previous 12 months, 34% reported having had a threat of legal action, 39% had to answer a formal complaint, 67% had been verbally or physically abused by patients or relatives and 29% had patients who had suicided. Overall, psychiatrists were more pessimistic about the future than optimistic and 15% said they would not do psychiatry again. There were few differences according to state of origin or type of practice. However, females differed from males in several areas. CONCLUSION: Helping patients was reported as the main source of satisfaction for Australian psychiatrists while not being able to provide the best care for patients was described as one of the main reasons for dissatisfaction. Although most Australian psychiatrists are satisfied and proud of their profession, they are stressed and often experience verbal or physical abuse and threats of legal action and complaints. They are apprehensive about the future. The increasing number of females in the profession, their higher levels of stress and dissatisfaction, and other differences from males must be taken into account as the profession reshapes its future. There is a need for regular surveys of this kind.

Adult↗

PubMed1992

European initiatives and the occupational hygiene profession.

This paper summarizes the development of occupational hygiene in Europe where the recognition of this profession is still not adequate especially at the political and governmental level. The role of international organizations or associations such as the World Health Organization (WHO) and the International Occupational Hygiene Association (IOHA) is emphasized and illustrated by a few examples. Although not promoting the occupational hygiene profession as such, the European Community is playing a significant role in the development of this discipline by its active policy in the field of health and safety at work. The other relevant actors in this respect are the International Labour Office (ILO) and the dynamic and proficient national societies such as the Italian Association of Industrial Hygienists and the British Occupational Hygiene Society. A few of the most relevant challenges in the development of this indispensable discipline are finally presented. One of the highest priorities is training and education since a profession cannot evolve and continue to grow without fresh blood.

European Union↗

PubMed1990

Concepts of quality of care: national survey of five self-regulating health professions in Canada.

Discussions of quality assurance mechanisms for health professions are increasing in Canada. In their roles of protecting the public from incompetent or unsafe health care, and enhancing the quality of care provided by practitioners, provincial licensing organizations are taking an interest in quality assurance programmes. The paper reports the results from a national survey of five self-regulating health professions (dentistry, medicine, nursing, optometry and pharmacy) in Canada. The study found two types of activities in place--a complaints programme and a routine audit programme. Both programmes use a similar approach to identifying poor performers within a health profession. The paper discusses the results of the study, the advantages and disadvantages of the approach used, and suggests a second approach to quality assurance which could be used in conjunction with current activities.

Canada↗

PubMed1991

A review of the validity and accuracy of self-assessments in health professions training.

Valid self-assessment is fundamental to continuing professional competence but is seldom explicitly taught in health professions training. This review analyzed 18 scholarly articles published between January 1970 and February 1990 (14 articles regarding health professions trainees, and four concerning college students or graduate trainees) in which it was possible to compare performance as self-assessed by trainees with performance as assessed by experts or objective tests. The validity of self-assessed performance was found to be low to moderate and did not improve with time in conventional health professions training programs. Self-assessed performance seemed closely related to generalized self-attributions and was minimally influenced by external feedback in the form of test scores, grades, or faculty assessments. In five programs emphasizing explicit self-assessment goals and training strategies, moderate-to-high validity outcomes or improvements over time were demonstrated. Much of what passes for self-assessment in training seems the exercise of an underdeveloped skill, but effective training to improve validity and accuracy is available and feasible.

Health Personnel↗

PubMed1996

A state university's model program to increase the number of its disadvantaged students who matriculate into health professions schools.

Health professions schools often provide support for minority and disadvantaged students in high school or in a single college summer program. However, long-term support for students during their undergraduate years is also crucial. Since 1990, San Diego State University (SDSU), a large urban public university, has implemented the Health Careers Opportunity Program (HCOP) to increase the number of the university's disadvantaged students (most of whom are from minority groups) who matriculate into medical, dental, veterinary, and physician assistant schools. The program's 11 components, each dedicated to some form of educational intervention and support, emphasize developing students' collaborative learning skills, fostering their pride in accomplishment, and helping them achieve positive self-images and self-confidence; these goals are linked with building students' analytical and problem-solving skills. Weekly journals kept by students' mentors serve as an "early warning system" for "bad" feelings, attitudes, and behaviors that reflect students' personal problems and correlate with lower grades, and help the program staff work intensively with students immediately, before problems become severe. The SDSU's HCOP increased the number of disadvantaged (mostly minority) students staying in the prehealth career path (not counting those in the schools of nursing and public health) from 70 in 1989 to 360 in 1995. In 1992 through 1994, the students who had completed the HCOP's Summer Academic Program (to help them bridge into a science curriculum) had pass rates for entry-level math, writing competency, and math placement that were consistently higher than the rates for other SDSU students. The overall grade-point average of HCOP students in the spring of 1995 (3.05) was significantly higher than the overall GPA of all minority students in prehealth training before the HCOP began (2.59 in 1988). The number of SDSU's minority students accepted by health professions schools (primarily medical schools) rose significantly from six in 1990 to 23 in 1995. It is clear that the labor-intensive interventions of the HCOP throughout students' years at SDSU until they matriculate into health professions schools are working.

California↗

PubMed1996

Profession building in the new health care system.

To further the goals of greater legitimacy and power, it is necessary for nursing to abandon many of the profession building strategies it has pursued in the past. We describe the traditional framework for profession building in nursing and some reasons it is no longer effective. In contrast, a contemporary framework for profession building in nursing is presented. Because nursing, like other complex adaptive systems, is strongly anchored by its past trajectory, it will require considerable energy and resources to make the transition.

Health Care Reform↗

PubMed2003

Trust and satisfaction with physicians, insurers, and the medical profession.

BACKGROUND: Conceptual or theoretical analysts of trust in medical settings distinguish among markedly different objects or types of trust. However, little is known about how similar or different these types of trust are in reality and the relationship of trust with satisfaction. OBJECTIVES: This exploratory study conducted a comparison among trust in one's personal physician, health insurer, and in the medical profession, and examined whether the relationship between trust and satisfaction differs according to the type of trust in question. RESEARCH DESIGN: Random national telephone survey using validated multi-item measures of trust and satisfaction. SUBJECTS: A total of 1117 individuals aged 20 years and older with health insurance and reporting 2 healthcare professional visits in the past 2 years. RESULTS: Rank-order correlation analyses find that both physician and insurer trust are sensitive to the amount of contact the patient has had and their adequacy of choice in selecting the physician or insurer. Trust in the medical profession stands out as being uniquely related to patients' desire to seek care and their preference for how much control physicians should have in making medical decisions. Adding satisfaction to the models reduced the number of significant predictors of insurance trust disproportionately. CONCLUSIONS: Consistent with theory, we found both substantial similarities and notable differences in the sets of factors that predict 3 different types of trust. Trust and satisfaction are much less distinct with respect to health insurers than with respect to physicians or the medical profession.

Adult↗

PubMed2002

A loss of faith: the sources of reduced political legitimacy for the American medical profession.

The political legitimacy and policymaking influence of the medical profession have greatly declined in American society over the past 30 years. Despite speculation about the causes, there has been little empirical research assessing the different explanations. To address this gap, data collected in 1995 are used to compare attitudes of the American public and policy elites toward medical authority. Statistical analyses reveal that (1) elites are more hostile to professional authority than is the public; (2) the sources of declining legitimacy are different for the public than they are for policy elites; and (3) the perceptions that most threaten the legitimacy of the medical profession pertain to doubts about professional competence, physicians' perceived lack of altruism, and limited confidence in the profession's political influence. This article concludes with some speculations about the future of professional authority in American medicine.

Attitude to Health↗

PubMed1990

Health visiting: a withering profession?

Over the past 2 years, community nursing appears to have been quietly marginalized within successive government health documents. The health visiting profession in particular looks to be under the greatest threat, and it is to that issue that the discussion will be addressed. The argument will be made that changing the content of health visiting practice in an attempt to solve the apparent problems, is not sufficient in itself to both protect and allow development of the profession for the 21st century. It is of more relevance to determine the direction for health visitors within the rapidly changing context of primary health care provision. The potentially worrying changes in the community health agenda for health visitors will be demonstrated by some analysis of the Cumberlege Report 1986, the 1987 White Paper Promoting Better Health, the Griffiths Report on Community Care 1988, and the NHS Review 1989 Working for Patients. Potential avenues for action are explored, including neighbourhood nursing, and a serious attempt at membership of primary health care teams within general practice. The conclusion is that health visitors need to indulge in some painful decision-making, in order to prevent the withering away of their profession within the newly emerging context for primary health care delivery.

Aged↗

PubMed2004

Lecturer practitioners in six professions: combining cultures.

BACKGROUND: Whilst research has been undertaken in relation to the lecturer practitioner role in nursing, there have been no cross-professional studies. There is an explicit political agenda in the United Kingdom on interprofessional education and enhancing the status of those who provide practice-based teaching. AIM: This paper reports a study to investigate the commonalities and differences between lecturer practitioners across professions and to generate hypotheses about the role, which follows different models of practice in the different professions. METHODS: An exploratory research design was adopted, using semi-structured interviews with a purposive sample of lecturer practitioners from six professions (architecture, clinical psychology, law, medicine, nursing and social work). A grounded theory approach was used. FINDINGS: All lecturer practitioners perceived a clear dichotomy between their professional practice role and their university role. All used similar strategies to adapt to and deal with combining two very differently perceived cultures. There were striking similarities in response to the consequences of serving "two masters" in the areas of time management and role identity/definition. CONCLUSIONS: The role not only bridges theory and practice, but has to operate within very different organizational cultures. Further research is needed to test the generalizability of the findings. Relevance to clinical practice. This investigation aims to inform higher education and health service policy on lecturer practitioners, and also provide support for those undertaking this challenging role. The study poses challenging questions for policymakers in the current climate of interprofessional learning, which need to be addressed if future initiatives in this area are to be successful.

Adaptation, Psychological↗